Endocrine Abstracts

Introduction: Bisphosphonates are widely used to treat osteoporosis, hypercalcemia of malignancy and multiple myeloma. Albeit rare, bisphosphonate induced osteonecrosis of jaw is serious adverse event which significantly affects quality of life. Clinical presentation includes gingival ulceration, exposed necrotic bone in the oral cavity. In severe cases it may cause spontaneous pain, tooth mobility and pathological fractures.

Case Report: A 70-year-old man, on treatment for multiple myeloma for past 10 years, presented with loosening of teeth in right fourth quarter of mandible associated with pain and purulent discharge. He had type 2 diabetes and hypothyroidism. He w s on thalidomide, monthly dexamethasone as part of his chemotherapy. On examination there was a soft nodular swelling in right inferior border of mandible. Intra oral examination revealed instability of right mandibular body with sequestration and pus collection. Cone beam computed tomography revealed four missing teeth in right lower quadrant (Teeth 44,45,46,47), loss of alveolar bone, osteomyelitis and pathological fracture of right body of mandible. Histopathological examination revealed necrosis of bone and plasma cells. He was treated with intravenous antibiotics. Sequestrectomy and reconstruction with Recon plates was done in view of osteomyelitis.

Conclusion: Osteonecrosis of jaw is a rare but serious complication of bisphosphonate therapy. To prevent this known complication a comprehensive, meticulous dental evaluation should be performed prior initiating bisphosphonate therapy. Patients should be educated about the importance of oral hygiene to reduce the risk of osteonecrosis of jaw. We should be highly vigilant in patients with multiple myeloma, where use of steroids as chemotherapy can be an additional risk factor.